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Group Exercise Infection Control of Aerosol Transmissible Diseases

Group Exercise Infection Control of Aerosol Transmissible Diseases. Scenario.

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Group Exercise Infection Control of Aerosol Transmissible Diseases

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  1. Group ExerciseInfection Control of Aerosol Transmissible Diseases

  2. Scenario • You are a health care worker in a busy family practice clinic. A mother calls for an same day appointment. Her 4 year old child developed a fever ~ 3 days ago and it’s getting worse. The receptionist has scheduled the appointment for 2 PM. • 2 PM: The family walks into the waiting room. The receptionist is concerned about a contagious illness because the child has a rash. She asks you, the clinic charge nurse, to immediately evaluate the patient.

  3. Question 1 Which aerosol transmissible diseases would you be concerned about? (fever/rash illness) airborne: measles, varicella (chickenpox) droplet: meningococcal disease, rubella (german measles) note: other infectious agents can cause fever/rash but are not on ATD list

  4. Scenario (continued) The receptionist obtained this additional history: The family has just returned from a vacation to Europe. The child has had a fever, runny nose, cough, for 3 days. Initially the fever was 101ºF but has been increasing, and was 104ºF today. Her child developed a rash last night which is spreading.

  5. CDC Photo / Barbara Rice You immediately recognize this as a possible case of _________

  6. Question 2 What would you do? Hint: • source control and HCW protection • At triage promptly screen & isolate patients with fever and rash • Mask & isolate suspect cases (negative pressure – if not available, private room with door closed) • HCW protection • Ensure HCW immunity. Only immune persons to enter room. • N95 respirator • Determine vaccination status; other risk factors? • Check vaccine records. If not available, check immunization registry www.cair.org. Note- hx MMRx2 does not preclude measles • International travel to endemic area/ foreign visitors

  7. Question 2b If the mother had given a history of fever, rash over the phone • What policies/procedures should be in place to avoid potential exposures? • Phone call protocol for fever, rash, especially if concern re: varicella /measles- If notified in advance, schedule an appt late in the day, avoid others, separate entrance if possible. If ATD suspected, child to wear mask, consider evaluating patient in car/outside building • Office protocol for fever, rash • Ensure source control • HCW protection • Ensure respiratory protection program in place • Vaccination policy

  8. Scenario (continued) • You review the chart for vaccination. • The parents have declined vaccination for their child in the past. • Physician examines the patient. Makes diagnosis of probable measles. • writes orders to send child to the laboratory to have blood drawn for a serologic test for measles.

  9. Question 3 • What arrangements should be made for laboratory testing ? Avoid exposure to others.Discuss with local health dept for best strategies. Draw blood in office if possible. Some health depts can assist w specimen collection & testing. If necessary to send to a commercial lab, alert first. Arrange blood draw at end of day, mask patient, only those with measles immunity should see patient . Phlebotomist should wear N95 respirator. • Should any one else should be notified ? • Any special instructions/precautions as the family leaves?

  10. Question 3 (continued) • Should any one else should be notified ? • Contacts should be notified Alert public health immediately; public health will coordinate follow up of contacts • Any special instructions/precautions as the family leaves? • Mask patient. Leave by separate entrance if possible, avoiding contact w/ others. Stay at home during infectious period unless medically necessary.

  11. Question 4 • What about the examination room after the patient leaves? • Close door. Do not use any regular exam room for at least 2 hours after a suspect measles patient has left room. • Decontaminate high-touch surfaces before next use.

  12. Measles • highly contagious, 90% attack rate • Prodrome – fever, cough, coryza, conjunctivitis 2-4 days • Rash – begins on face & head, spreads, lasts 5-7 d • Infectious 4 days before to 4 days after rash onset • Incubation period (exposure to first symptoms) 14 days (7-18 d) • person to person, respiratory droplet and airborne transmission • documented airborne up to 2 hrs after person with measles occupied the area in enclosed spaces) • One in 1000 children with measles die • Increasing cases in CA (international travel, vaccine refusal)

  13. http://www.cdph.ca.gov/programs/immunize/Documents/IMM-908.pdfhttp://www.cdph.ca.gov/programs/immunize/Documents/IMM-908.pdf

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